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Commissioning care services for older people in England: the view from care managers, users and carers

Published online by Cambridge University Press:  25 June 2003

TRICIA WARE
Affiliation:
Nuffield Institute for Health, University of Leeds.
TIHANA MATOSEVIC
Affiliation:
Personal Social Services Research Unit, London School of Economics.
BRIAN HARDY
Affiliation:
Nuffield Institute for Health, University of Leeds.
MARTIN KNAPP
Affiliation:
Personal Social Services Research Unit, London School of Economics.
JEREMY KENDALL
Affiliation:
Personal Social Services Research Unit, London School of Economics.
JULIEN FORDER
Affiliation:
Personal Social Services Research Unit, London School of Economics.

Abstract

One of the key objectives of the community care reforms of 1990 in the United Kingdom was the development of a flourishing independent sector alongside good quality public services. The aims of the reforms were to increase the available range of options, widen consumer choice and promote independence. The purpose of the study reported here was to examine – from the perspective of older service users, their carers and care managers – experiences at the operational level of arranging, delivering and receiving care services. The findings are based on data gathered in seven local authorities including reviews of case files, policy documents and face-to-face, in-depth interviews with 55 users, 37 carers and 28 care managers. There is evidence of a pronounced emphasis on procedure-based systems of care management. Potentially this has two significant consequences. First, the fostering of personal relationships may be subordinated to the organisation of short-term tasks and thereby may threaten patterns of trust and accountability. Second, the associated fragmentation of the assessment and care management process which in turn can lead to discontinuities of care for users and their carers. The paper concludes that there is still some way to go before care managers as micro-commissioners have sufficient and reliable information or available service capacity to match providers' capabilities with users' and carers' needs.

Type
Research Article
Copyright
© 2003 Cambridge University Press

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